jueves, 16 de junio de 2016

Vía aérea difícil / Difficult airway

Junio 16, 2016. No. 2359

Anestesia regional en vía aérea difícil. Continúa la búsqueda de una solución
Regional anesthesia in difficult airway: The quest for a solution continues.
Anesth Essays Res. 2016 May-Aug;10(2):178-83. doi: 10.4103/0259-1162.167829.
Difficult airway, a scenario with potentially life threatening outcome, is routinely encountered by an anesthesiologist leaving him with the dilemma of whether to use regional anesthesia (RA) or general anesthesia. Our study aims to look into this problem. The literature search was performed in the Google, PubMed, and Medscape using key words "regional anesthesia, difficult airway, pregnancy, ventilation, intubation, epidural anesthesia, nerve blocks." More than 38 free full articles and books published from the year 1987 to 2014 were retrieved and studied. At first sight, RA may appear to offer an ideal solution as it helps to avoid the problem of difficult airway. However, the possibility of a total spinal block, failed or incomplete RA, local anesthetic toxicity or unforeseen surgical complication may make it imperative that the airway is secured. The correct decision can only be made by the anesthetist when all the relevant clinical information is taken into account. It is also important to ensure that before considering RA in a patient of difficult airway, an anesthesiologist must have a preformulated strategy for intubation.
KEYWORDS: Difficult airway; epidural anesthesia; intubation; nerve blocks; pregnancy; regional anesthesia; ventilation

El encuentro con vía aérea difícil inesperada: la relación con la escala de intubación difícil.
Encountering unexpected difficult airway: relationship with the intubation difficulty scale.
Koh W1, Kim H1, Kim K1, Ro YJ1, Yang HS1.
Korean J Anesthesiol. 2016 Jun;69(3):244-9. doi: 10.4097/kjae.2016.69.3.244. Epub 2016 Jun 1.
BACKGROUND: An unexpected difficult intubation can be very challenging and if it is not managed properly, it may expose the encountered patient to significant risks. The intubation difficulty scale (IDS) has been used as a validated method to evaluate a global degree of intubation difficulty. The aims of this study were to evaluate the prevalence and characteristics of unexpected difficult intubation using the IDS. METHODS: We retrospectively reviewed 951 patients undergoing elective surgery in a single medical center. Patients expected to have a difficultintubation or who had history of difficult intubation were excluded. Each patient was assessed by the IDS scoring system with seven variables. Total prevalence of difficult intubation and the contributing individual factors were further analyzed. RESULTS: For the 951 patients, the difficult intubation cases presenting IDS > 5 was 5.8% of total cases (n = 55). The prevalence of Cormack-Lehane Grade 3 or 4 was 16.2% (n = 154). Most of the difficult intubation cases were managed by simple additional maneuvers and techniques such as stylet application, additional lifting force and laryngeal pressure. CONCLUSIONS: Unexpected difficult airway was present in 5.8% of patients and most was managed effectively. Among the components of IDS, the Cormack-Lehane grade was most sensitive for predicting difficult intubation.
KEYWORDS: Difficult; Grade; Intubation; Scale; Unexpected

16th World Congress of Anaesthesiologists
28 August - 2 September 2016 
Hong Kong Convention and Exhibition Centre
World Federation of Societies of Anaesthesiologists
Cursos de Anestesiología en Chile, 2016
Facultad de Medicina. Pontificia Universidad Católica de Chile
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